Gingivitis (inflammation of the gums) usually precedes periodontitis (gum disease). In the early stage of gingivitis, bacteria in plaque (a sticky, colorless film of bacteria that forms on teeth) causes the gums to become inflamed, often bleeding. At this stage the teeth are still firmly embedded in their sockets and no irreversible bone or other tissue damage has occurred. However, if left untreated, gingivitis can advance to periodontitis. In periodontitis, the inner layer of the gum and bone pull away from the teeth and form spaces called pockets. These pockets collect debris and often become infected. Toxins, which are produced by the bacteria in plaque, and enzymes produced by the body as it fights the infection, cause the breakdown of the bone and connective tissue that anchors the teeth. As the disease progresses, the pockets deepen and more bone and connective tissue are destroyed. Eventually the teeth are no longer anchored in place and become loose, often leading to tooth loss. In fact, periodontitis is the leading cause of tooth loss in adults.
Plaque is the primary cause of gingivitis and periodontitis. However, other factors can contribute to these diseases as well, including hormonal changes associated with pregnancy, puberty, menstruation, and menopause, all of which can make gums more sensitive and easier for gingivitis to develop. In addition, many illnesses can affect the gums. Such illnesses include diseases such as cancer or HIV infection, both of which can interfere with the proper functioning of the immune system. Diabetics are at generally at a higher risk of developing infections than non-diabetics, including periodontal disease. Medications can also affect oral health because some can decrease the flow of saliva, which has a protective effect on the teeth and gums. Smoking makes it harder for gum tissue to repair itself. And of course poor oral hygiene such as not brushing and flossing on a daily basis makes it easier for gingivitis to develop. A family history (genetics) of dental disease can be a contributing factor for the development of gum disease, as well.
Researchers have identified potential links between gum disease and other serious health conditions such as stroke and heart disease. Diabetes is not only a risk factor for gum disease, but gum disease may make diabetes worse.
Surgical treatments for gum disease include flap surgery/pocket reduction surgery. During this procedure the gums are lifted back and the tarter is removed. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can accumulate. The gums are then placed so that the tissue fits snugly around the tooth. This method reduces the size of the pockets between the gum and tooth, thereby decreasing the areas where harmful bacteria can grow. Bone grafts involve using fragments of the patient's own bone, synthetic bone, or donated bone to replace bone destroyed by gum disease. The grafts serve as a platform for the regrowth of bone, which restores stability to the teeth. New technology, called tissue engineering, encourages the body to regenerate bone and tissue at an accelerated rate. Soft tissue grafts reinforce thin gums or fills in areas where gums have receded. Grafted tissue, most often taken from the roof of the mouth, is sutured in place, adding tissue to the affected area. Guided tissue regeneration is performed when the bone supporting the teeth has been destroyed. This procedure stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth. Bone surgery smooths shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.
Current non-surgical treatments for gum disease include professional dental cleaning to remove the plaque and tartar, which is plaque that builds up and hardens on the tooth surface, from above and below the gum line. Often a professional dental cleaning is recommended more than twice-a-year. Scaling and root planning are deep-cleaning, nonsurgical procedures done under a local anesthetic, whereby plaque and tartar from above and below the gum line are scraped away (scaling) and rough spots on the tooth root are made smooth (planing) Smoothing the rough spots removes bacteria and provides a clean surface for the gums to reattach to the teeth.
Antibiotic therapy can be used either in combination with surgery and other therapies, or alone, to reduce or temporarily eliminate the bacteria associated with gum disease or suppress the destruction of the tooth's attachment to the bone. Chlorhexidine is an antimicrobial used to control plaque and gingivitis in the mouth or in periodontal pockets. It is available as a mouth rinse or as a gelatin-filled chip that is placed in the pockets after root planing and releases the medication slowly over time. Other antibiotics, including doxycycline, tetracycline, and minocycline may also be used to treat gum disease. In addition, a nonprescription toothpaste that contains fluoride and an antibiotic to reduce plaque and gingivitis, called triclosan, may be recommended.
Many therapeutic agents in development today are complex biological substances. For example, some are cells or cell-derived substances. In contrast to small molecule agents which are relative inexpensive to make, the complex biological substances are very expensive to make. As a consequence, they are generally much higher in price than traditional small molecule agents. Therefore, there is a need to reduce the required volume of the biological substance to the lowest possible efficacious amount in order to control costs. In accordance with this goal there is a need for a drug delivery device that is capable of delivering a small volume of a therapeutic agent precisely to the interproximal area between and around the teeth. Such delivery would provide a cost-efficient treatment option for patients suffering from dental diseases, disorders or injuries, e.g., periodontal (gum) diseases.